By U. Akrabor. Christopher Newport University. 2019.

The negative symptoms contribute to poor quality of life generic bactroban 5 gm on line acne 415, functional disability buy 5gm bactroban with visa acne 6 dpo, and lack of motivation quality 5 gm bactroban acne y embarazo, and have been linked to folate deciencies (see below) order discount bactroban line acne 37 weeks pregnant. Cognitive symptoms, including decits in working memory and executive function, are related to the ability to function in society. Conceptual disorganization e circumstantial speech, loose, tangential, illogical associations 2. Occurrence of hallucinations with a single voice in a running commentary of patients activity, or two or more voices or voices that are bizarre can be used singly for diagnosis. Endophenotypes are: (1) heritable characteristics that co-segregate with disease in a family; (2) disease state independent (i. During this period the individual may spiral out of control and engage in reckless self- damaging decisions involving gambling, other nancial activity, sexual activity, etc. Today, treatment includes intensive education along with behavioral and occupational ther- apies, but there are no standard medical interventions. Brain dysfunction may be due to a disparate range of environmental and/or genetics factors. For instance, response to medication or infectious disease can present with behavioral 134 symptoms. In 1988, Templer and Cappelletty [45] proposed separating primary and second schizophrenia into different categories based on features of disease as shown in Table 7. This view is gaining more importance as genetic studies have failed to reveal clear-cut causes of neurobehavioral disease. Recently, Sachdev and Keshavan published a comprehensive text entitled Secondary Schizophrenia [46] that brings together for the rst time information on primary disease that may present symptoms of neurobehavioral dysfunction. In some cases, the primary disease involves damage to the brain, especially in the temporal lobe, that goes undetected because appropriate screening is not done. When conventional medical testing of individuals suspected or given a psychiatric diagnosis is not done, medical conditions in these patients go untreated. The push for routine health assess- ment and care for patients with neurobehavioral disorders is increasing (for instance, see [48]). Medical testing is critical for helping patients with underlying pathologies that impact symptoms, or that impair the quality of life, and for research purposes where disease and symptoms need to be clearly dened. Few studies have rigorously examined the environmental factors that can lead to remission, although recently consensus standards for remission and recovery are being developed to facilitate treatment and research [59]. Epigenetics in Human Disease unfortunate because patients without severe brain damage may present opportunities for reversal of disease, perhaps through epigenomic manipulation. Clearly, the development of new and effective treatment modalities will require further dissection of neurobehavioral disease types. Penetrance describes the level of phenotypic expression of a genetic trait in individuals with a causal mutation. Admittedly, treatment for a disease caused by a dominant mutation is more difcult than a disease due to a recessive mutation because the mutant allele or its product must be eliminated. The causes of disappointing genetic results can be true false positives from small sample sizes and inadequate statistical criteria; true heterogeneity in disease and/or inadequate gene testing. Perhaps the application of second-generation ultra-high-throughput sequencing for complete genome and/or complete gene sequencing will clarify gene association results. These studies are generally used to look for linkage disequilibrium between genes, i. Low penetrance is attributed to several factors including: (a) epistasis (interaction between genes, i. Epistasis is commonly invoked to explain the large number of genes linked to neurobehavioral illnesses. Other mutations affecting epistasis may decrease or increase protein activity and affect which pathway step is rate-limiting. Mutation may lead to a loss, gain, or change of function, each with different consequences. Despite the spectrum of possible epistatic affect, epistasis does not account for some genetic observation on neurobehavioral illness. For instance, epistasis cannot explain the discordance rates of disease in monozygotic twins. Discordance in monozygotic twins has traditionally been used to distinguish between genetic and environmental components of disease especially when twins are raised apart. However, although monozygotic twins share the highest percentage of their genome, their genomes are not identical because of somatic and epige- nomic changes. Monozygotic twins that develop from the same fertilized egg are discordant for neuro- behavioral disease at levels that are signicantly below 100%, i. Variation in concordance rates may be due to several factors including differences in ascertainment of disease and/or twinship. More recently studies have used standardized methods for disease diagnosis and quantitative, rather than qualitative, assessment of twinship. Some patients come from families where related individuals have the same or a related neurobehavioral disorder (or an associated endophenotype); others have, arguably, no family history (aka spontaneous forms of illness). This result underscores the importance of prevention through environmental interventions. In fact, paternal age is generally linked to negative neurobehavioral outcomes [79]. Increased paternal age is asso- ciated with increases in other diseases such as Down syndrome; neural tube defects (see discussion of folate below); congenital cataracts; and reduction defects of the upper limb [80,81], with the greatest affect seen in autosomal dominant mutations [82e84]. Undernutrition (general caloric or protein deciency) and malnutrition (deciencies in specic elements, e. Moderate to severe undernutrition occurring prior to 2 years of age is associated with persistent behavioral and cognitive decits that resist nutritional rehabilitation [85].

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Pain usual wanes by 2 to 3 weeks buy discount bactroban 5 gm online skin care therapist, but Indications should be emphasized that the diagnosis of lesser discomfort may persist for much longer buy bactroban 5gm line acne mechanica. For sural nerve b iopsies buy cheapest bactroban and bactroban acne 10 dpo, there is a for a specific cause of neuropathy cheap bactroban 5gm online acne tretinoin cream 005, whic h may be an issue with nerve biopsy; sampling of a single sensory deficit along the lateral aspect of the diagnosed with certainty only by pathologic segment of a single nerve may miss multif ocal foot, which generally recedes or even resolves by examination. Conditions for which peripheral nerve biopsy is occur in the nerve proximal or distal to the site of most helpfulfor dia gnosis include: biopsy. In addition, nerve biopsy may fail to Vasculitis demonstrate significant pathology in small-fiber Sarcoidosis neuropathies. In that situation, skin biopsy to Miscellaneous Amyloidosis examine intraepidermal small nerve fibers may Tumor infiltration be a more powerfultech nique. New York: Oxford University (myelin-associated glycoprotein) hematoma, wound infection, and wound Press, 2001:90-123. It can also be painful, both dur ing the procedure and in the postoperative period. The appearance of x-ray imaged structures depends dilated pupils, bleeding diathesis, or Fastideal for uncooperative and critically ill on their density. Water is arbitrarily assigned the anticoagulation, and all penetrating head patients value of zero, with de nser structures like bone injuries. No ionizing Granulomatous disease Drug infusion pumpsgenerally not radiation is involved. T1W images are obtained after Direct multiplanar ima ging screws, nails, dental devices (e. Fat suppression No beam hardening artifacts related to bone joint replacements, spinal rods), ocular implants, images help identify lesions obscured by fat. Functional Limitations imaging such as diffusion and perfusion imaging is invaluable in evaluation of stroke. Often this is transient and eliminated by Many contraindications are relative; it is best to reassurance from the technologist. Magnetic resonanceimaging of the carcinomatosis, R/O drop metastases brain and spine, 3rd ed. These Instructions for Patients include arachnoid cysts, meningoceles, and arachnoiditis. Furthermore, with the exception of oral medications beginning spinal cord and associated nerve roots within myelography allows for the collection of spinal 4 hours pr ior to the exam. In patients with a prior the thecal sac via the intrathecal injection of fluid for analysis. Patients with poor renal sac and its contents allows for the indirect function who are not being dialyzed are hydrated diagnosis of extradural compression of spinal Limitations prior to the procedure. Glucophage (metformin) nerve roots and spinal cord as well as the should be withheld temporarily (48 hours) prior inference of intradural neoplasms, to myelography due to potential risk for renal arachnoiditis, and arachnoid cysts. Plain failure and reinstated only after renal function Myelography can depict spinal cord morphology myelography does not accurately depict nerve has been reevaluated and found to be normal. This information is often usefulfor and headache following the procedure, patients surgical planning especially in the cervical spine. Avoid placing a Usually use surface stim ulation, less often Motor neuron diseases (e. Instructions for Patients Usually performed using a small needle placed into the muscle(s) of interest. Davis, Is it focal in a nerve root (or radicular) neuropathies, nerve responses may be 2001. The peak systolic velocity is the most accurate and reproducible Doppler parameter measured and Strengths Contraindications is therefore the most commonly reported. Sonography instruments with two transducers that does not involve the use of contrast agents and Preparation/Special continuously emit and receive ultrasound has no risks or contraindications. A single transducer specificity of Doppler threshold measurements alternatively emits and then receives ultrasound for detecting stenosis of greater than 50% by signals. Measurements of carotid endarterectomy, concern about the The quality of ultrasonographic results is percent stenosis or cross-sectional area can be extension of the stenosis into the inaccessible dependent on the experience of the examiner made in sagittal or transverse images, distal internal carotid artery, the possible and interpreter as well as the equipment used. Color Doppler flow imaging adds presence of significant stenosis in the cavernous Some patients image p oorly, and those with color-coded blood flow patterns. Using a carotid artery, the coincidental existence of large, thick necks may be difficult to study. Examination of the vertebral and the transducer probe is moved on the neck Several large multiinstitutional studies suggest artery is limited by anatomic accessibility to the from above the clavicle to the angle of the jaw. Such a correct assessment of stenosis or occlusion correlation has not been demonstrated with difficult. For these reasons most practitioners use ultrasonography as a screening tool to exclude patients with no carotid artery stenosis from further testing and rely on results from conventional angiography before recommending carotid endarterectomy. The acute inflammatory demyelinating polyneuropathy type is clinically similar to Incidence/Prevalence N/A Guillain-Barre syndrome. Autonomic Exact incidence/prevalence figures are not neuropathy causes orth ostatic dizziness, available. See Dementia, Focal Brain Lesions, and All races affected; most common in Caucasians neuromuscular topics for a more detailed Other specific tests may be helpful in certain and blacks. Mild edema and/or mass effect may be progressive multif ocal leukoencephalopathy progressive headache, confusion, lethargy, noted. Encephalitic inflammation and secretion of toxic cytokines patients present with acute confusion, (e. Patients with persistent activity), electromyography and nerve conduction neurologic deficits should be considered for rehabilitation.

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Nasogastric tube only in situ to help nutrition because of orophayngeal and oesophageal candidiasis cheap bactroban 5 gm on line skin care hospitals in bangalore. Keratitis is a severe buy bactroban 5 gm with mastercard skin care zahra, rapidly deteriorating infection involving Spontaneous pneumothorax (36 discount 5gm bactroban free shipping acne in your 30s. Other infections in the lung are mainly multiple small dendritic and then geographic ulceration and with bacterial pathogens and mycobacterium: in low-and frequently to perforation buy online bactroban acne and hormones. Open thoracic surgery is fraught with serious pulmonary Conjunctival carcinoma (28. There appears to be an increased susceptibility to ultraviolet light in the presence of human papilloma virus-16 infection. It may be absent in the mouth though present in Abdominal wall abscess, the oesophagus! Diffuse oesophagitis may be due to herpes simplex, and result in ulceration; discrete ulceration is more likely due to There may be a complex mass of adhesions with all of the cytomegalovirus. They often may affect any abdominal organ, including the pancreas, result in strictures. However in areas of high endemicity, a high lymphocyte count in the ascitic fluid K. Tuberculous colitis (mimicking ulcerative colitis), Tuberculosis of Fallopian tubes and ovary, L. Cryptococcal peritonitis, multiple superficial small white Lymphoma or tuberculoma is likely to be the diagnosis in nodules seen on the omentum and serosal surfaces, a younger patient; tuberculous abscess of the liver or spleen Mesenteric thrombosis (12. Hepatitis is common: either with hepatitis B or herpes virus, Although Caesarean section reduces the transmission of cryptococcus, or induced by drugs. Less commonly there are obstructive Pelvic inflammatory disease, pelvic lymphadenitis and symptoms leading to urinary retention. The development of fistulae, unrelated to obstetric trauma are seen in sexually watering can scrotum and perineum is frequent. Cervical carcinoma is 10 times more frequent, affects younger females, and is more aggressive; recurrence is Fourniers gangrene (6. Herpetic vulvovaginitis, often ulcerative, is common and huge extensive vulval condylomata very often seen. Cystoscopy reveals a highly characteristic Condylomata may be very profuse on the foreskin and uniformly congested appearance with no ulceration and no may encroach onto the glans penis and into the urethral significant reduction in bladder capacity. Many of the lesions are resistant to treatment, and their Patients may request circumcision (27. The operation of circumcision is not However, do not undertake elective anorectal surgery without risk: severe necrotizing fasciitis of the penis can occur lightly: many authors have reported poor or absent wound post-operatively. Distal septic a microangiopathy associated with balanitis; this may be the complications such as meningitis may also occur. Furthermore there rather than the reverse as in the classical Fourniers gangrene. Proctitis: Just as in colitis, the rectum may be affected by a Many fistulae arise from sepsis, but some as a result of severe inflammatory process; cytomegalovirus, herpes extension of the idiopathic anal ulcer described above. Coli may be the In these cases, the fistula is wide and may readily admit the cause. Any major artery can be involved; the pathology affects mainly the adventitia with leucocytoclastic vasculitis of Anal and perianal warts (26. Contact tracing in poor-resource fragmentation of muscle and elastic tissue, and similar environments is a pipe-dream, and therefore recurrence by fragmentation in the internal elastic lamina of the intima, reinfection is frequent. Thrombosis may also occur in mesenteric vessels, or cerebral arteries resulting in a cerebro-vascular accident. Aneurysms tend to occur in the carotid and superficial femoral arteries, although any artery may be involved and multiple lesions are seen. Deep vein thrombosis occurs with 10 times greater frequency, though you will detect less than 1% of cases clinically. Risks of surgery are obviously further increased when you take this statistic into consideration, especially as you can use prophylactic anticoagulants only with reluctance in the presence of thrombocytopenia. The larger the implant, the bigger the problem: bone infections then often fail to respond to antibiotics, removal of the implant, debridement and subsequent sequestrectomy. Explain fully the merits and demerits of internal fixation before you carry out any such operation. Despite appropriate treatments, infections frequently do Neuropathies and myelopathies are common, resulting in not resolve and amputation may be necessary. The arthritis may arise as a result of reaction of diarrhoea Chronic anaemia is common with bone marrow bacterial fragments carried in the circulation: aspiration yields suppression of single or multiple cell lines. Platelet numbers may be Inflammatory conditions of tendons and ligaments, satisfactory, but their function not so. Total globulin levels Guillain-Barr disease rise, with drop in albumin/globulin ratio. Use simpler Perianal excoriation cold staining methods: flood the smear with concentrated carbol fuchsin for 10mins without heating, and wash with <100/ Disseminated herpes Lipodystrophy water; then flood the smear with Gabbets methylene blue l simplex for 2mins and again wash with water. Respiratory candidiasis Salmonella (non-typhi) Gabbets methylene blue: Methylene Blue 1G, Absolute Alcohol 30ml, Concentrated Sulphuric Acid 20ml + Distilled Water 50ml. If patients do not complete their treatment courses, or if If the patient has had treatment before, initial treatment is many different treatment regimens are used, resistant probably best in hospital: use longer treatment phases: strains are likely to develop. A willingness and commitment to long-term therapy is essential; consider the financial costs, and the potential Control neuropathy with Isoniazid with Pyridoxine barriers ahead. Treat co-morbidities, and manage (Vitamin B6) 50mg tid; prophylactic treatment is 20mg od. Treatment to reduce mother-to-child transmission is now standardized: use zidovudine 200mg at the onset of Occasionally you will need to substitute one drug for another labour. If pains turn out to be false labour, try a repeat dose of the same type: get advice about this.

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Safety and effectiveness of a selective strategy for coronary artery revascularization before transcatheter aortic valve implantation buy bactroban 5gm with amex acne 7 day detox. Revascularization for unprotected left main disease: evolution of the evidence basis to redefine treatment standards discount bactroban 5 gm without prescription skin care coconut oil. Stenting of the unprotected left main coronary artery in patients with severe aortic stenosis prior to percutaneous valve interventions discount 5gm bactroban acne jeans review. Since the first percutaneous transcatheter aortic-valve implantation in humans in 2002 buy bactroban american express skin care jakarta barat, over 50,000 transcatheter aortic valves have been implanted worldwide. However, since this therapy is not yet approved for clinical use in Japan as of September 2013, little is known about its safety and efficacy in Japanese patients. In-hospital course was uneventful, and she was discharged 6 days after the procedure with a significant improvement in symptoms. An embolic stroke was diagnosed after the procedure, and two month rehabilitation was needed. Procedure- and age-specific risk stratification of single aortic valve replacement in elderly patients based on japan adult cardiovascular surgery database. Reducing manipulation of the stenosed native aortic valve may therefore potentially decrease the rate of cerebrovascular events. Study and control groups were similar regarding their respective demographics and risk profile at baseline. Incidence of major access site complications was low with only one case (2%) in either group. Cerebral embolization during transcatheter aortic valve implantation: a transcranial Doppler study. They have a higher incidence of comorbidities and an increased risk for 1,2 periprocedural complications associated to preoperative coronary angiography compared to younger patients. Coronary angiographies were performed by experienced operators with at least 500 transradial procedures within the previous 12 months. Procedural failure was defined as the need to change to another vascular route to complete the coronary angiography. The use of the contra-lateral radial or the femoral artery as the second access was left to operator criteria. Vascular complication was considered when hematoma>5 cm or radial artery perforation occurred. Categorical variables are expressed as absolute or relative frequencies and are compared using Chi-square or Fishers exact test. In all cases, the coronary angiography was finally completed without any additional problem. Vascular complication (hematoma>5 cm or radial artery perforation) occurred in 7 patients (1%). Comparision of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians. Unfortunately, despite extensive work, the best management for asymptomatic carotid stenoses is not yet fully resolved. Drawing conclusions from the published studies comparing surgical vs medical management of asymptomatic carotid stenoses is complicated by the differing techniques of measurement (duplex scan vs arteriography) and variations in the definition of which lesions are critical (ranging from 60 to 80 percent). Further, the modern medical management of patients with advanced atherosclerosis has been substantially impacted by successful risk factor modification and the more expansive use of statin drugs and novel antiplatelet compounds. In this abstract, we will present the key points in advocacy for judicious intervention on asymptomatic carotid stenoses. The focus is not whether endarterectomy or stenting is best but simply when any interventional treatment is beneficial The risk of asymptomatic carotid lesions is low, arguing against treatment in most high risk patients Recent randomized trials have furthered our understanding of the natural history of asymptomatic carotid stenoses and the slim but real benefit of prophylactic endarterectomy in patients less than 75 years of 1 age. In this large multi-national study of more than 3000 patients, this cohort of patients experienced a 40-50% reduction in non-perioperative stroke risk over 10 years (reduction for men 17. However, the benefit of surgery was markedly narrowed in all patients when the end point was defined as any stroke or perioperative death; the risk of such undesirable outcomes at 10 years in non-operated patients was 17. Further, in the first 2 years after randomization these specific endpoints were actually worse for operated patients than those undergoing medical treatment. Importantly, irrespective of endpoint, there were no significant benefits of surgery in patients over the age of 75. Continuing improvements in the treatment of hypertension and the development of more effective antiplatelet and plaque stabilizing drugs (statins) argue that the risk of asymptomatic lesions may be even less in recent years. More attention should be paid to defining the likelihood of later embolization of asymptomatic lesions based on the composition of bifurcation plaques andThere is increasing evidence that plaques prone to embolization have a different character then those apt to remain clinically silent. As a consequence, it is reasonable to assume that those asymptomatic plaques proneother morphologic criteria. As well, ultrasound findings of ulcerations or predominantly hypo-echoic structures on color-coded duplex examination 4 are significantly more common in symptomatic than asymptomatic patients. In a series of papers, Bassiouny et al clearly demonstrated a higher likelihood for plaque rupture, intraplaque hemorrhage and macrophage related inflammation in bulky plaques. Indeed the volume of the plaque was more predictive of these histologic risk factors then the degree of 5 stenosis. Recent studies on explanted plaques have demonstrated potentially important differences between plaques in women and men; women have less macrophage infiltration and stronger smooth muscle staining, 6 implying a less intense inflammatory process. This could help explain why the natural history of asymptomatic carotid lesions is more benign in women. It also suggests that better noninvasive assessment of the metabolic activity and morphology of all lesions, irrespective of gender, might lead to better stratification of risk then the degree of stenosis alone. That said, it must be acknowledged that such detail has been a holy grail for some time and has not yet been achieved with any real accuracy. Malloy and colleagues tried to assess the potential of symptoms using transcranial ultrasound to detect 7 embolic signals in the middle cerebral artery in 111 patients.

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Mutagenic agents The chemical substances and environmental conditions which cause mutations in the organisms are called mutagens or mutagenic agents order on line bactroban acne on arms. Chemical mutagenic agents Chemicals can also be used for inducing mutations in the organisms buy genuine bactroban skin care not tested on animals. Ethyl methane sulphonate 123 has been extensively used for inducing mutations in microorganisms bactroban 5 gm with mastercard skin care doctors orono, higher plants and animals order bactroban 5gm visa acne adapalene cream 01. Significance of mutation m Mutations play an important role in the origin of new species and serves as a tool for evolution. Mutant varieties of wheat are early maturing, disease resistance and they are enriched with protein. Cistron is an unit of function, recon is the unit of recombination and muton is the unit of mutation. Chromosomal aberrations In an organism, any visible abnormality in chromosome number or structure from the diploid set is known as chromosomal aberration. The chromosomal aberrations based on the structure of the chromosome are of four types deletion, duplication, inversion and transversion. Structural chromosomal aberrations Deletion The loss of a segment of the genetic material in a chromosome is called deletion. When the deletion occurs near the end of the chromosome, then it is called terminal deletion. When the deletion occurs in the middle of the chromosome then, it is called intercalary deletion. Duplication When a segment of a chromosome is present more than once in a chromosome then, it is called duplication. Inversion It is another chromosomal abnormality in which, the order of genes in a chromosomal segment is reversed by an angle of 180. In pericentric inversion, the inverted segment of the chromosome contains centromere. For example the 17 human chromosome is acrocentric, while in Chimpanzee the corresponding chromosome is metacentric. In paracentric inversion, the inverted segment of the chromosome has no centromere. When translocation occurs between two non-homologous chromosomes, then it is called reciprocal translocation or illegitimate crossingover. In heterozygous translocation, one member of each pair of chromosomes is normal and the other member is with interchanged segment. But in homozygous translocation, both the members of paired chromosomes have translocated segments. Numerical chromosomal aberrations Each species of an organism has a specific number of chromosomes in its somatic cells. Alterations in the number of chromosomes from the diploid set is called numerical chromosomal aberration. Euploidy Euploidy is the variation in the chromosome number that occurs due to increase or decrease of full set of chromosomes. Diploidy In most of the plants and animals, the somatic cells contain two sets of chromosome. Polyploidy Addition of one or more sets of chromosomes to the diploid set results in polyploidy. Watermelon, grapes and banana are autotriploids, whereas apple is an autotetraploid. Allopolyploidy Increase in one or more haploid set of chromosomes from two different species result in allopolyploidy. It is obtained by crossing a wheat Triticum durum (2n = 4x = 28) and a rye Secale cereale (2n = 2x = 14). Then the chromosome number is doubled using colchicine and it becomes an hexaploid. Parent Triticum durum x Secale cereale 2n = 28 2n = 14 (2n = 4x = 28) (2n = 2x = 14) F hybrid (sterile)1 2n = 21 (2n = 3x = 21) Chromosome doubled (Colchicine treatment) 2n = 42 (2n = 6x = 42) Hexaploid Triticale 129 Aneuploidy Variation that involves one or two chromosomes within the diploid set of an organism results in aneuploidy. Hypoploidy Decrease in one or two chromosomes from the diploid set is described as hypoploidy. Nullisomy is the condition in which a pair of homologous chromosomes is lost from the diploid set i. Hyperploidy Addition of one or two chromosomes to the diploid set of chromosome results in hyperploidy. Trisomy results due to the addition of one chromosome to diploid set of chromosomes. Tetrasomy results due to the addition of two chromosomes to diploid set of chromosome. Significance of ploidy m Polyploidy plays an important role in plant breeding and horticulture. R-type cells S-type cells Heat killed S-type cells Heat killed R-type cells S-type cells Fig. The virulent strain synthesized a smooth polysaccharide coat and produces smooth colonies. Another strain which lacked the proper polysaccharide coat is harmless and produces rough colonies. Griffith killed some smooth strain bacteria and mixed it with live rough strain bacteria. When the mixture of heat killed S-type cells and R-type 132 cells was injected into the mouse, the mouse was dead. That is the hereditary material of heat killed S-type cells had transformed R-type cells into virulent smooth strains. They are complex macro molecules and made up of millions of smaller units called nucleotides.

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